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stephanie boville nutritionist registered dietitian-01

Do you ever get the “runs” on the run?? What about stomach pains, burping, nausea or flatulence? If the answer is yes, you are not alone. In fact, 30-50% of endurance athletes struggle with gastrointestinal (GI) issues and is a common reason for underperformance. This rate sky rockets to 90% in athletes training and competing in ultra-endurance events. In this article you will learn how a few nutrition tactics can help you have a GI issue free run!

Why do we experience these GI issues?

There are a few reasons why with intense prolonged activity there seems to be a higher prevalence of GI issues:

  1. Increased blood flow to the muscles and away from the gut may result in malabsorption of nutrients
  2. Increased blood flow to the muscles and away from the gut may result in damage of the gut lining resulting in bacteria and nutrients passing through the gut (increased permeability leading to endotoxemia)
  3. Delay gastric emptying (ie slower movement of the food from stomach to intestines) can cause upper GI issues such as nausea, reflux or burping
  4. Change in transit time of food leading to speeding up or slowing down of food movement through the GI tract

Interesting note: research is showing that the gut damage is highest in those who ran their marathon fastest yet had the least symptoms, leading the researchers to believe that some people are more sensitive to the higher levels of gut permeability and damage. One other possible reason for this is the individuals gut microbiome, where an imbalance of good and bad bacteria (dysbiosis) may be the difference from having symptoms or not.

What can we do about it?

First off, you want to consider if your GI issues are constant. If the answer to that is yes, you should consult your doctor to rule out any underlying GI diseases such as crohn’s or ulcerative colitis.

Secondly, you want to make sure you employ good nutritional habits prior to making major changes to the diet like we will discuss below. First things to consider are meal and snack composition and timing. Eating the wrong thing too close to exercise can lead to inadequate time to digest the food leading to cramping and stomach discomfort. Keeping balanced larger meals 3-4h before exercise is recommended. As you move closer to the exercise consuming smaller, more carbohydrate based snacks tends to work best. Avoiding high fat, high protein, high fibre foods close to exercise can be another strategy to reduce stomach discomfort. Limiting coffee/caffeine and lactose (sugar in milk/yogurt) close to workouts can be helpful. It is also important to train the gut to handle carbohydrates during your workouts, and NEVER EVER try something different on race day.

What about Gluten?

If you have tried the above recommendations and are still finding it difficult to make it through your workouts and races without GI issues, there are a few new strategies that have been researched. Gluten is often eliminated by elite athletes on the assumption that it causes them GI pain. About 40% of non-celiac athletes will eliminate gluten for at least 50% of the year due to GI reasons. Although they anecdotally find this helps reduce symptoms, research does not always support this and often shows gluten elimination in non-celiac individuals does not result in decreased GI symptoms or inflammation.

Another line of thought regarding why athletes anecdotally see GI improvement when eliminating gluten-rich foods is they are also eliminating fructans (which are considered to be a FODMAP)

FODMAP’s are a collection of short chain fermentable carbohydrates. If they are malabsorbed and or are present in the colon they can be used to feed the good bacteria (prebiotic) causing gas, bloating and other GI symptoms.

Fermentable

Oligosaccharide- carbohydrate chain with 3-10 sugar units (barley, rye, black beans, cashews,   garlic, onion, beets)

Disaccharide: carbohydrate chain with 2 sugar units like lactose (cows milk, yogurt, sour cream)

Monosaccharide: single sugar unit like fructose (found in fruit, apples, fig, mango, pears and sweeteners like high fructose corn syrup)

and

Polyols: sugar alcohols found in sugar free gum and candy (sorbitol, maltitol, xylitol)

A recent research study by Wiffin et al. (2019) investigated the effect of a short term (7 day) high and low FODMAP diet on GI symptoms during exercise. They had 16 participants, both male and female complete the two dietary interventions in a random order with a one week wash out period between trials. They found that low FODMAP diet resulted in overall improvement of GI symptoms. On an individual basis 69% of the participants reported a positive effect of the low FODMAP diet on symptom management, specifically for pain and bloating. They also show that participants perceived they were able to train more frequently and intensely on a low FODMAP diet.

Warning: Low FODMAP is not a lifestyle!

Low FODMAP should not be followed on a daily basis as it can be restrictive and alter your gut bacteria as these carbohydrates are important prebiotics (they feed the good bacteria in your gut). It is also important to make sure you have a good dietary plan if you follow this diet to make sure you have adequate carbohydrate provision for your activity, especially if you are trying this before a big race. Following the diet for 3-7 days prior to a race is recommended if you do find it helpful to reduce your GI symptoms. If you continue to have GI pain during training, doing a FODMAP elimination and reintroduction technique should be used to find foods that you are more sensitive to and how much your body can handle.

Recap:

  • Is your GI pain occurring all the time? If so, seek medical advice and testing
  • Look at meal timing and composition
  • Train your gut and practice your race day nutrition to avoid unexpected surprises
  • Potentially employ a short term low FODMAP diet prior to important races

I hope this information helps you run free of GI pain. If you would like more information on implementing a low FODMAP diet, I am ready to help. It is my passion and goal to help you be the best athlete you can be. For more information, visit the clinic website!

References:

Lis, Dana M. Exit gluten free and enter low FODMAPs: A novel dietary strategy to reduce gastrointestinal symptoms in athletes. Sport Medicine. 2019. 587-597. https://doi.org/10.1007/s40279-018-01034-0

Wiffin Melanie, Smith Lee, Antonio Jose, Johnstine James, Beasley Liam, Roberts Justin. Effect of a short-term low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet on exercise-related gastrointestinal symptoms. Journal of the International Society of Sports Nutrition. 2019. 16:1. https://doi.org/10.1186/s12970-019-0268-9

Sigma Nutrition Radio Danny Lennon Episode 246 with Jamie Pugh- Gastrointestinal Symptoms in Athletes.

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marathonnurition

** H+P, Run Waterloo members, Runners’ Choice running club members and WCC members receive a $50 discount!

Let us help you take full advantage of what the latest research is showing with regards to endurance sports nutrition!  Stephanie has 6 years of post-secondary education at her disposal.  Learn more about her HERE.  Along with adapting to each individual’s needs, each session will include the following topics (and more):

Session 1: Initial Assessment and Workout Nutrition Optimization (1 hour)

Initial assessment and key initial changes such as protein distribution and pre/post workout.

Session 2: Training the Gut & Nutrition During (45 minutes)

How to train your gut to tolerate more carbs, how and when to take your carbs acutely before and during, how to accurate calculate and plan your fluid intake.

Session 3: Hydration continued and GI distress (45 minutes)

Other factors to consider when optimizing hydration and exactly how to modify your diet in the days leading into race day to decrease the odds of GI distress.  Touch open sleep and recovery.

Session 4: Carb loading (45 minutes)

How to shift your diet away from protein/fats/fibre toward carbs in that week pre-race.  How much and when to eat your carbs in the days leading into your competition.

Session 5: Supplement Review (45 minutes)

Vitamin D, dietary nitrates (beat juice), caffeine, salt pills, Omega-3s and beyond.  What do you need to be taking during?  What do you need to take directly before and during a race?  What actually works, and what should you stay away from?

PLUS:

  • 3 follow up e-mail discussions leading into your 2-3 key races.
  • A custom, detailed carb loading plan leading into your A-races.

This plan will arm you with what the most up-to-date research shows works.  Stephanie will help you ensure that you are properly fuelled and energized for race day so that you can reveal your full fitness potential!  If you are interested for yourself or a loved one, please contact us at (519)885-4930 or info@drdelanghe.com.

If you haven’t seen it, here it is- Canada’s NEW food guide.   So what exactly are the differences, and has it really changed that much?  Our registered dietitian, Steph Boville, has some thoughts!

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What I think of the new Canada’s Food Guide

To be perfectly honest, I rarely pulled out the old rainbow Food Guide when talking to my patients. If you don’t remember the old guide, it was a rainbow representing the 4 different food groups which were arranged in order of foods you needed the most servings from to the least. The main focus of the diet was on vegetables and fruit, followed by whole grains, milk and alternatives and finally the food group you needed the least servings of was meat and alternatives. From there they gave guidelines such as eat more vegetables than fruit, eat at least half your grains as whole grains, choose beans and lentils often etc. They then prescribed a number of servings for each food group based on age and gender.

The reason I didn’t use the guide was because it was meant to be an education tool to learn about different food groups and their purpose rather than provide practical steps to get someone to follow the prescribed servings.  Plus, people generally know the focus of their diet should be on vegetables and fruit but this needed to be more visual, practical and user friendly. For these reasons I found easier and more effective ways to communicate the information in the guide in my own way, not to mention nutrition is not a one-size fits all and therefore did not use the guide in my practice.

The New Guide

The new Canada’s Food Guide encompasses many important aspects of eating and also provides consumers with more specific guidelines about foods to choose more or less often in a very visual way. There has been a lot of hype about the new food guide, both good and bad (like everything… everyone has their own opinion!). I honestly think that the information has not changed, rather how it has been communicated has.  These changes in communication have been extremely positive.  The new Food Guide is very similar to values that guide my counselling style and advice.

The visual of the plate, with half the plate covered in a variety of deep colourful vegetables and fruit, a quarter of your plate as your whole, unprocessed grains and starches and a quarter of your plate as your plant or animal protein sources. This communicates very easily and simply how you want your plate to look compared to the prescription like recommended servings of the past Food Guide. The new guide still promotes the same values as before: eat real foods, include lentils and plant proteins, lean proteins, whole grain carbohydrates and more vegetables, with less sodium, saturated fats, processed foods and sugar. All of these values line up with my own personal beliefs and what the evidence shows.

There are a few things I really like about the new guidelines. It is more interactive and web-based rather than a physical pamphlet which may be better for our tech-savvy population. Not only is the visual of the plate very easy to see, understand and apply, but it also acknowledges the social aspect of food and promotes building a healthy relationship with food. This is also a foundational value of Bodzii (personalized nutrition and lifestyle coaching), where we think it is important to have both good food quality and a good food mentality. For example, viewing food in a positive light such as thinking of what a food can do for you, not to you. There is a wide range of information for consumers on practical ways to be mindful of your eating habits, benefits of cooking more often, ways to enjoy your food, benefits of when you eat meals with others, how to use food labels, and how to be aware of food marketing along with much more.

What about the dairy? Everyone is freaking out that dairy is no longer a “food group”. One thing I think the Food Guide needed to do was separate themselves from organizations and give an unbiased, easy to use guide for consumers in which takes “food politics” or influences out of the equation. Dairy is still in the guide, just as the other food groups such as grains and meat and vegetables are. However, there is a shift from food groups to a “macronutrient” like approach. This means that the dairy products are now represented in the protein portion of the plate. This DOES NOT mean that milk is considered unhealthy. As always, milk (soy, pea and cow milk) still provides us with protein, vitamin D and calcium for strong bones, teeth and muscle function.

Overall, the new changes to the Canada’s Food Guide are more in line with I have been teaching and promoting all along. The guide may not satisfy everyone depending on what “nutrition camp” you belong to such as keto, paleo or even elite athletes. It is not meant to be a one size fits all model, rather what the best evidence shows a balanced diet looks like for a healthy normal human. The bottom line is to not over complicate your nutrition. Focus on getting your vegetables, whole grains and lean proteins to meet your needs. Also remember to find ways to enjoy your food and to be mindful of what and how you eat along with striving to enjoy home cooked meals when possible.

I hope this helps to clear up some confusion you may have been experiencing with regards to this new guide.  If you have any additional questions, don’t be afraid to contact me at the clinic! 

DSC_0131

Oh hey, I’m back! It’s been a while. My hiatus from writing didn’t coincide with a break from reading though, and I have accumulated a number of tidbits and interesting thoughts on training and performance to bring to you in 2019!  No promises on the frequency of the articles, but I shall do my best.

Today, we’re starting with one we all need to know about: the warmup.

It’s something I’ve written about before- both in terms of cool additions that you really shouldn’t implement (such as here), how a warmup doesn’t literally mean warming up and what we’re actually after (glycogen mobilization and increase in blood flow to our running muscles), and even how it relates to carbohydrate ingestion (here).

Warmup Duration

One thing I get asked about often enough at H+P is why my warmup protocols vary so drastically from distance to distance. For instance, for 5K and under, the warmup is longer with drills. For the marathon, the warmup is just long enough to make sure your shoes won’t come untied and to keep the mind relaxed.

CLICK HERE to read the rest in the WRS Magazine 

wlflyer

Let us help you take control of your health!  Stephanie has 6 years of post-secondary education at her disposal.  Learn more about her HERE.  Along with adapting to each individual’s needs, each session will include the following topics (and more):

First visit: Initial assessment and diet optimization

Second visit: Science and role of carbohydrates and carbohydrate quality

Third visit: Quality fats, micronutrients and sleep optimization

Fourth visit: Intuitive eating and responding to hunger

Fifth visit: Planning and goal setting for transitioning out of dieting

Sixth visit: Wrap up and measurements

This plan will arm you with what the most up-to-date research shows works.  No fad diets, fasting, cleanses, or cutting out foods you love.  Stephanie will help you conquer your challenges not only from a dietary standpoint, but a biopyschosocial standpoint- your mind and behavior matters if this is going to work!

If you are interested for yourself or a loved one, please contact us at (519)885-4930 or info@drdelanghe.com.

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Our clinic had a great time at the 2018 Fall 5K Classic!  We had a huge group of runners out with our learn to run group who started from ground zero going all the way to running their first 5K ever (or at least first 5K in a long time).

It was amazing to see all of our teammates cross the finish line with a mix of smiles and exhaustion on their faces!  Running a race for a beginner can be super daunting and intimidating task, but this crew banded together and conquered the challenge with hard work and positive attitudes from start-finish.  For those who signed up with the team, our crew ended up averaging a very impressive time of 29:59!   Not all of you appeared on this list for various reasons, sorry about that!  Check out the full results HERE.

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Here are some of our favourite pictures of the team from the event.  You can check out our full album here.

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OH and HUGE bonus points goes to Mark for winning the coveted Run Waterloo quilt in his first race ever!

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Our learn to run group runners weren’t the only ones active that day!  Our practitioners and front desk crew all participated as well!

Our CPR instructor, Emily Hunter was in 1st for the team with a great time of 20:12!

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Physio Kayla was in next for the team with a solid new personal best of 20:46!

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Amanda had an awesome race!  The only Olympic medalist to ever wear an H+P singlet, she ran a strong 25:45 in her first race of any type since her Olympic career and having two kids!

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Sean ran with his mom, Gail, and she ran a new personal best of 26:04!

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Our registered dietitian, Steph, had an awesome race running 31:24 despite being stopped by the traffic at Westmount/Erb!

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Karen had a great time with the squad as well and will be back for more next time!

Combined our employee team finished 3rd in the corporate competition with an average time of just over 22 minutes!

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Thank you everybody for joining us on this journey, it was so much fun to do this as a team.  See you out on the roads sometime soon!

 

Version 3

In general, our society is becoming more health conscious, which is great! People are living longer and are looking to feel younger as they age. I often work with aging athletes, and older adults to help provide guidance on how they can use different nutrition strategies to help them reach their goals, whether health or fitness related. One of the most common issue these I find older adults face including recovery, strength and body composition changes. If you are over 50 I would encourage you to keep reading!

Sarcopenia

Sarcopinia is the term used to describe the gradual muscle mass loss seen in older adults. We know that in general once you hit age 50, you start to lose about 1% of your lean body mass per year. This is concerning for a few reasons. First, the loss of muscle mass means you will also likely lose functionality, ie you may be unable to lift groceries like you used to. It also can result in changes in balance and stability which may lead to increased risk of falls. Lastly, because our muscle mass is a metabolically active tissue (ie it stores and burns carbohydrates and fats) the decreased muscle mass can decrease the metabolic efficiency and storage of carbohydrates and fats and can lead to development of chronic diseases such as cardiovascular disease or type 2 diabetes. This results in a huge stress on our health care system and therefore is important for us to think about nutrition strategies to maintain our muscle mass as we age.

Why do we lose muscle mass?

It is not known for certain why we lose muscle mass as we age, whether we have a general decreased muscle building and/or increased muscle breakdown or a lower sensitivity for turning on protein synthesis (ie it takes more protein to increase muscle building). Either way, in general this leads us to have higher muscle breakdown than build up, and thus a loss of lean tissue.

What can we do about it?

The first point I want to make is not related to nutrition. It is well known that resistance training is a VERY powerful stimulus of muscle building capacity and aged muscles respond to resistance training similar to young muscles. Resistance training in combination with very easy nutrition changes can help retain, maintain and possibly even build muscle mass in older adults.

 Nutrition Strategies

  1. Increase the protein intake

In a westernized country like Canada, we often get enough protein, however I do notice that older athletes or adults may still need to bump up their intake to maximize recovery. The reason for this recommendation is because we know that an older adult will not respond to a 20g dose of protein like a younger person would, and a higher dose of protein is needed to stimulate muscle building. Some older adults experience decreased appetite and will reduce portions, again we need to keep in mind we need more protein to maintain our muscle mass compared to when we were young!

  1. Protein quality is important

Research does show that soy protein vs whey or beef protein is less effective to stimulate muscle building. Even though soy is a complete protein (has the same amino acid make up as meat) it seems as though it is processed slightly different in the body. Mainly, the protein in soy seems to be digested slower resulting in less of an increase in amino acid levels in the blood and thus decreased stimulation of muscle protein synthesis. Very careful nutrition planning is necessary if you are an older adult who adheres to a vegetarian or vegan diet.

  1. Dairy

Dairy has the amino acid Leucine, which is a branch chain amino acid. It is a potent stimulator of muscle synthesis and can assist in maintaining lean mass. Not only is dairy a source of leucine, but adding a glass of milk to your meal will add about 8g of protein, which actually could be all the changes you need to make to meet the protein needs at your breakfast, lunch and dinner. In addition, consuming dairy products will provide you with calcium and vitamin D to assist in prevention of osteoporosis! Win win right?!

  1. Distribution

We talked about the amount, quality and now we get to the timing! If we look at typical protein amounts at each meal of the general population, we typically consume very little protein at breakfast, moderate amounts at lunch and a HUGE portion at dinner. This is a very skewed distribution of your protein and very little protein synthesis occurs until the dinner time, where not all of that protein can even be used and is wasted. Having multiple doses throughout the day at regular time intervals is the best method of feeding and maintain your muscle mass. You also want to make sure you place your protein at appropriate times to ensure adequate recovery from exercise bouts.

  1. Supplements

If you are an older adult who is engaging in regular exercise, supplements like protein powder might be common place in your dietary plan. One other supplement that has been shown to have some benefits for older adults is creatine. First we must understand that lifting a weight for 8reps the activity is more intense and it lasts very little time and therefore it will use anaerobic metabolism for the most part, which means that you will be using the phosphocreatine pathway to provide energy along with carbohydrates. The theory is that the more creatine in the muscle, the harder you can train, thus getting a better workout and getting a larger response of muscle strength and growth. It can be used to stimulate your muscle building potential. Research does show that proper dietary strategies + weight training + creatine supplementation can result in additional muscle building, increased strength and also increase in functional movement. Proper dosing is needed to elicit results, and there are a few contraindications for using such a supplement, independent assessment for this supplementation is needed.

As our population ages, it is predicted that at year 2050 a quarter (25%) of the population will be over the age of 65. This may put strain on our health care system, and therefore we need to make sure we do as much as we can to keep our bodies healthy as we age. For more information about how you can keep your body healthy as you age, book an appointment today!

Version 3

We are back at it again, and this time I want to talk a little bit about nutrition concerns for the male endurance athlete. If you have been following along with my previous blogs (if you haven’t, you should be!), you will recall we discussed how nutrition impacts the health and wellbeing of female endurance athletes, especially regarding stress fracture risk. You can find it here, if you would like to take a look back for a refresher.

For a quick recap, we discussed how endurance running is a huge metabolic demand, meaning it costs a lot to run fast for long periods of time. This can result in accidental under consumption of macronutrients (carbohydrates, fat and protein), energy, and ultimately vitamin/mineral intake, or purposeful restriction of food intake to achieve a desired level of thinness or body shape. Chronic under consumption, whether accidental or not, of both nutrient and energy, can cause some physiological changes in the body and can greatly increase your risk of bone related injuries.

It was typically believed that low energy availability (LEA), in the past known as the female athlete triad, only was a complication females encountered in sport, however it is now known that males also experience negative health and performance effects of LEA. It is possibly harder to detect in males, as there is no clear sign, such as loss of menstrual cycle, however that is why we need to be careful not to miss the subtle signs. In this article we will discuss what happens physiologically with LEA, and its effects on bone mineral density (BMD).

Physiological Changes
Under consuming energy can be a difficult concept to understand because calculations of exercise energy expenditure, basil metabolic rate and even energy intake are difficult to assess. Current research defines “Energy Availability” (EA) as the left over energy to be used for normal physiological processes after accounting for energy expenditure, which is expressed as kcal/kg of FAT FREE mass.

The EA equation= [energy intake- exercise energy expenditure] / fat free mass (kg)

Physiological Changes With LEA
– Decreased metabolic rate
– Increased cortisol (stress hormone)
– Decreased testosterone
– Signs include fatigue and decreased sex drive

Bone Mineral Density
There is ample evidence to suggest that an active individual have higher BMD than sedentary individuals. Within the athletic population swimmers and cyclists tend to have fairly low BMD due to non-weight bearing nature of the exercise. A study by Viner et al. looked at male and female cyclists with lower than expected BMD. The found that 70% had LEA across the entire training cycle, including pre season, competition and post season. This points to the theory that this particular group may have had low BMD due to their LEA. They found that 40% of the participants had low bone mineral density in their lumbar spine, and 10% had low bone mineral density in the femoral neck. The athletes were followed for 1 year and their BMD stayed the same, which is positive. The researchers pointed to their previous interventions of increasing vitamin D & calcium intake and including weight training as a reason for the maintenance of BMD. This provides evidence that a good nutrition and training intervention can help maintain bone strength.

Another study in elite male endurance athletes showed that LEA resulted in low testosterone (although not clinically low) however it did not result in any differences in BMD compared to those with normal testosterone levels. There seems to be a caloric value threshold before we start to see negative health and bone effects. Interestingly, it seems as though women are more sensitive to changes in EA, where we see significant and detrimental effects in heath and bone when their EA reaches 30 kcal/kgFFM/day or below. There is evidence that this occurs at levels of 20-25 kcal/kgFFM/day in a male athlete, although more research is needed to confirm this. This study suggested that because they investigated athletes at ~30kcal/kgFFM/day that this was not enough of a deficit to result in decreased BMD. However, this does not mean you can neglect your nutrition planning because even though their BMD did not change, those with low testosterone had 4.5x more risk of sustaining a stress fracture and had 4.5x more missed training days due to injury.

Main Take-Away:
In elite endurance athletes, 40% of males were found to have LEA. Even temporary low EA increases bone breakdown and decreases bone building, and chronic low EA has long lasting effects on bone health plus many more effects such as mental health and performance to name a few. Therefore, it is essential to stay on top of your nutrition as a part of stress fracture/injury risk reduction.

1. Negative energy balance and testosterone: studies show low testosterone results in 4.5x higher risk of bone injury and had 4.5x more missed training days due to injury
2. NFL players and vitamin D: In NFL players, low circulating vitamin D levels correlated with increased risk of core and lower muscle injuries; players with 1+ fractures had higher rates of inadequate levels of circulating vitamin D.
3. Military recruits with lower serum Vitamin D- correlated with higher risk of fractures

References:
Viner RT, Harris M, Berning JR, Meyer NL. Energy availability and dietary patterns of adult make and female competitive cyclists with lower than expected bone mineral density. International Journal of Sports Nutrition and Exercise Metabolism. 2015. 25, 594-602.

Ruohola JP, Laaksi I, Ylikomi T, Haataja R, Mattila VM, Sahi T, Tuohimaa P, Pihlajamaki H. Association between serum 20(OH)D concentration and bone stress fractures in Finnish young men. Journal of Bone and Mineral Research. 2006. 21, 1483-1488.

Heikura IA, Uuitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. 2017. Low energy availability is difficult to assess but outcomes have a large impact on bone injury rates in elite distance athletes. International Journal of Sport Nutrition and Exercise Metabolism.

keto 1

If you have been following along in my past articles, you saw the evidence for whether or not a keto diet is beneficial for endurance athletes. However, I wanted to also share my thoughts and some research on the keto diet for my non-athlete readers. In this article I will discuss why keto may, or may not, be a good choice for you.

 First off, I want to say that keto is likely not meant to be a life-time eating style.

Typically for weight loss, keto could be used for 2-4 months and then one could switch into a long term maintenance phase where you are including healthy carbohydrates.

Secondly there are some warnings that come with the keto diet. Our brains and hearts run exclusively on carbohydrates and when we severely restrict carbs, our body needs to switch to the use of ketones for fuel instead. There is a 3-4 day period of “brain fog” when you initially switch to a keto diet, where your ability to think is reduced. Not to mention food selection is quite limited and your social life may take a hit due to your restrictions. Plus, fair warning, your breath will smell bad too!

There are risks!

Very close monitoring is required for implementing a keto diet (especially to assess if keto would be a benefit to you). You also have to have a solid plan for transitioning into a regular diet, which should also be lead by a dietitian or qualified health care professional. The latter is quite important. This is because when you starve yourself of carbohydrates and then suddenly reintroduce a large load of carbohydrates, the body switches to an anabolic (or build up) mode and causes increased insulin, increased uptake of carbohydrates into the cells, increased utilization of those carbohydrates, all which increases the uptake and use of potassium, magnesium, phosphate, thiamine and increased sodium and water retention. The sudden changes in these electrolytes and vitamins can cause serious issues that can be as severe as a heart attack. AKA you can not have a cheat day in a keto diet and have yourself a big old piece of cake.

iron sources

Keto & weight loss

Most of the research as a whole shows that you MAY lose more weight on a keto diet vs. regular diet.  However, when studies include body composition analysis they show that on average keto leads to more overall weight loss, but the amount of fat lost is the same. This means that keto diets lead to more muscle mass loss compared to a traditional diet.

Therefore, you may see a better outcome when you step on the scale but it may have less desirable body composition changes.

 The main reason for this finding is that you have to have a moderate protein intake while on a keto diet because protein can be used in a process called gluconeogenesis, where amino acids are (inefficiently) used to make glucose, thus keeping you out of ketosis, where as a traditional weight loss diet will be higher in protein to support the muscle mass retention. Other reasons could also include you can not have dairy, which has been shown to be an important food group to stimulate weight loss and muscle mass retention due to its leucine content.

It is also important to note that resistance exercise is a VERY powerful stimulus of muscle protein synthesis and muscle retention during weight loss, and regardless of diet should be included in your weight loss plan.

There may be benefits too

Keto may work for certain people. For instance, people who are on a keto diet often feel more satisfied with their diets. This is likely because higher fat foods are often pleasurable foods and provide flavour and mouth-feel to food (ie cheese, who doesn’t want to eat a brick of cheese every day!). Johnstone et al. (2008) conducted a study where participants were able to eat ad libitum (ie no restrictions or standards for caloric consumption) and participants were assigned to a keto group or a moderate carbohydrate group. They found that people on a keto diet felt less hungry, and lead to them eating less than compared to a moderate carbohydrate diet.

To my surprise, keto does seem to have a beneficial effect on decreasing blood glucose and HbA1c levels, decrease triglyceride levels, LDL cholesterol, and may increase HDL cholesterol levels. One thing I think is important to remember here is that in most cases, healthy dietary changes (ie more vegetables, fibre, less processed carbohydrates and sweets etc.), decreasing alcohol consumption, and increasing exercise can do the same for you, without doing something as intense or dramatic as a keto diet.

 Take home:

My personal and professional opinion on this is that I would first have someone try a to make healthy diet changes which would include consuming good sources of carbohydrates such as beans, lentils and whole grains before trying a keto diet. Keto in my mind is a last ditch effort if no other dietary interventions have worked.

Summary:

  • Keto diets can be somewhat dangerous and should be eased into and out of with the help of a qualified health care professional
  • Keto diets sometimes result in more weight loss but fat loss is comparable to typical diet
  • There must be a caloric restriction to create weight loss, no different than a regular diet
  • Keto may help keep you full and more satisfied with the diet and may help you adhere to the diet plan
  • Keto does seem to have beneficial therapeutic effects for type 2 diabetes, pre-diabetes and on blood lipid profiles (but so does healthy diet/exercise)
  • Ultimately the diet needs to be something you can follow and stick to before transitioning to your maintenance phase, if that’s keto, great!
  • Bottom line: Try traditional approaches first, if that is not successful, you could consider the keto diet for the short term and transition into a healthy diet intervention for maintenance

I hope you found this helpful, this is not a full list of keto uses and I did not list all the pros and cons for you, as I wanted to keep this conversation relatively short. If you have any further questions about dietary interventions for building a healthier you, please feel free to come in for a visit. To learn more about me, you can find my bio here.  

Reference:

Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. 2008. Effects of a high-protein diet on hunger, appetite and weight loss in obese men feeding ad libitum. Am J Clin Nutr. 87, 44–55.

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